The government has attempted to defuse MPs' damning criticism of the UK National Health Service's (NHS's) £12.4 billion IT programme, claiming that it is based on a National Audit Office (NAO) report that is "out of date".
The powerful Commons public accounts committee (PAC) released a sharply critical report on the National Programme for IT (NPfIT) in the NHS, warning that it was unlikely to deliver significant benefits, unless there was a fundamental change in the rate of progress on the 10-year project.
Committee chair Edward Leigh said: "There is a question mark hanging over the National Programme for IT, the most far-reaching and expensive health information technology project in history. Urgent remedial action is needed at the highest level if the long-term interests of NHS patients and taxpayers are to be protected."
NPfIT was "not looking good," he added. "The electronic patient clinical record, which is central to the project, is already running two years late. The suppliers are struggling to deliver. Scepticism is rife among the NHS clinicians whose commitment to the Programme is essential to its success. And, four years down the line, the costs and benefits for the local NHS are unclear."
The report also warns that estimates of the total cost of the scheme have varied between £6 billion and £20 billion. "Given that the total cost of this hugely ambitious project is expected to top £12 billion – and who can be confident that even this massive sum will not be surpassed? – the Department of Health is playing for high stakes indeed," Leigh said.
But health minister Lord Hunt hit back, saying: "This PAC report is based on a NAO report that is now a year out of date. Since then substantial progress has been made and the NAO recommendations have already been acted on. Costs of the programmehave not escalated.
"In fact, the NAO acknowledged that costs were under control and the strength of the contracts means that payment is not made until systems are delivered which protects the taxpayer."
He added: "The NHS IT programme will provide safer, faster and more efficient health care for patients, and we do not underestimate the challenges of delivering a system of this size and complexity. Working with the NHS and clinicians, we are on track to meet our broad targets and, as the NAO confirmed, well placed to deliver this exciting project."
Hunt's defense will not cut much ice with the PAC. During the committee's inquiry into NPfIT, MP Greg Clarke derided the tone of the NAO report. "In a year on the committee I have read 62 NAO reports. This is easily the most gushing," he said.
Earlier drafts of the NAO document revealed that many serious criticisms of the giant IT scheme were omitted from the final report, following a process of "clearance" with Department of Health officials.
The NAO has subsequently promised a second examination of NPfIT – an unprecedented move by the public spending watchdog. An NAO spokesperson confirmed that there would be a second inquiry, but said a timetable had not yet been set.
However, The PAC, the most powerful of all the select committees came to a series of stark conclusions:
- The delivery of the patient clinical record, which is central to obtaining the benefits of the programme, is already two years behind schedule and no firm implementation dates exist.
- The Department has not sought to maintain a detailed record of overall expenditure on the Programme and estimates of its total cost have ranged from £6.2 billion up to £20 billion.
- Total expenditure on the Programme so far is over £2 billion. The Department should publish an annual statement outlining the costs and benefits of the Programme.
- The Department's investment appraisal of the Programme did not seek to demonstrate that its financial benefits outweighed its cost.
- The Department is maintaining pressure on suppliers but there is a shortage of appropriate and skilled capacity to deliver the systems required by the Programme, and the withdrawal of Accenture has increased the burden on other suppliers, especially CSC.
- The Department needs to improve the way it communicates with NHS staff, especially clinicians.
The report says: "We are concerned that leadership of the Programme has focused too narrowly on the delivery of the IT systems, at the expense of proper consideration of how best to use IT within a broader process of business change."
The DoH should clarify responsibility and accountability for the local implementation of the program, it adds.
The MPs also warned that the use of only two major software suppliers may have the effect of inhibiting innovation, progress and competition.
Key components of the NHS National Programme
The heart of the NPfIT is the NHS Care Records Service, which is designed to replace local NHS computer systems with modern integrated systems and make key elements of a patient's clinical record – NHS number, date of birth, name and address, allergies, adverse drug reactions and major treatments – available electronically throughout England.
Other parts of the programme include electronic prescriptions, email and directory services for all NHS staff, Picture Archiving Communication Systems (computer accessible x-rays), and the Choose and Book system – a facility for patients to book their first outpatient appointments electronically.